Process issues predict time to endoscopy in upper-GI bleeding

Timing of endoscopy in patients with nonvariceal upper-GI bleeding is dependent on both clinical and process parameters, finds the latest issue of Gastrointestinal Endoscopy.

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Early endoscopy has been shown to improve outcomes and optimize cost-effectiveness in nonvariceal upper-gastrointestinal (GI) bleeding.

However, there is little information regarding clinical and process determinants that affect the time from onset of bleeding to performance of the endoscopy.

Dr Alan Barkun and colleagues from Canada evaluated factors that predict time to endoscopy in patients with new onset nonvariceal upper-GI bleeding.

Linear regression models were constructed with time between triage in outpatients or onset of bleeding in inpatients and the performance of endoscopy.

The team accessed the RUGBE, a nationwide, multicenter database collected for the purpose of obtaining descriptive data on these patients.

Endoscopy after working hours was associated with a shorter interval to endoscopy

Gastrointestinal Endoscopy

The study population consisted of 1500 patients who underwent gastroscopy within 48 hours.

The research team reported that the median time to endoscopy was 12 hours.

The researchers found that endoscopy after working hours was associated with a shorter interval to endoscopy.

Availability of an endoscopy nurse on-call for the procedure, and admission to a hospital unit were both associated with a shorter interval to endoscopy.

In contrast, the presence of chest pain or dyspnea, and absence of gross blood on rectal examination independently predicted delayed endoscopy.

The researchers noted that inpatient status at onset of bleeding was another independent predictor of a delayed endoscopy.

Subgroup analysis showed that actual time intervals as well as independent predictors of time until endoscopy differed between inpatients and outpatients.

Dr Barkun's team concludes, “The timing of endoscopy in patients with nonvariceal upper-GI bleeding is dependent on both clinical and process parameters, which differ between inpatient and outpatient settings.”

“They bear implications with regards to shaping practice and deciding on resource allocation in order to facilitate an early endoscopy, which is currently recommended for improved patient outcomes.”